[An approach to the diagnosis of recurrent attack of rheumatic fever in patients with rheumatic heart disease].

In order to evaluate recurrent attack of rheumatic fever (RARF) in patients with rheumatic heart disease (RHD), 97 patients with diagnosis of RHD for two years and more were included in this study. Progression of the lesions of cardiac valves was found in every case by comparing the echocardiographic and Doppler findings at present and two years ago. The history of the initial attack of acute rheumatic fever or the appearance of RHD were reviewed. The present complaints at admission and necessary laboratory procedures were studied. The data showed that 75 of the 97 patients had history of initial attack of ARF and the remaining 22 were symptomless with indolent carditis or carditis of insidious onset two years ago. In this admission, only 25 of the 97 patients had ARF in the Jones criteria were followed strictly, while the remaining 72 did not fulfill the criteria. It is suggested that if there is evidence of recent group a streptococcal infection, the conditions for diagnosis of RARF are as follows: 1) When one major or more than two minor criteria are present in a patient with RHD, a definite diagnosis of RARF may be made. 2) A presumptive diagnosis of RARF may be made, when a patient presents one minor criteria and several other manifestations such as anemia, abdominal pain, rapid sleeping pulse rate, tachycardia out of proportion to fever, malaise, epistaxis, precordial pain and an elevated level of IgG, IgA, C3 and circulating immune complexes.